# Analysis of Factors Affecting Postoperative Opioid Requirement in Adult Patients Undergoing Minimally Invasive Repair of Pectus Excavatum

## TL;DR

This study identifies factors like male sex, higher BMI, and longer surgery time that increase opioid use after pectus excavatum surgery in adults.

## Contribution

The study is the first to focus on adult patients and identifies specific perioperative factors linked to opioid requirements after MIRPE.

## Key findings

- Pain intensity peaks within the first 6 hours post-surgery and increases again between 24–48 hours.
- Male sex, higher BMI, and longer operation time are independently associated with increased opioid consumption.
- Multiple bar insertion correlates with higher opioid use in the first 6 hours after surgery.

## Abstract

Background/Objectives: Minimally invasive repair of pectus excavatum (MIRPE) is an established surgical treatment for adult pectus excavatum (PE). Compared with pediatric patients, adults generally have a more rigid chest wall and greater costal cartilage ossification, often resulting in more severe postoperative pain. However, most previous studies have focused on pediatric patients with PE and on evaluating effective analgesic methods. This study aimed to investigate perioperative factors associated with postoperative opioid requirements and pain intensity in adult patients undergoing MIRPE. Methods: This study was a single-center retrospective study of adult PE patients who underwent MIRPE between March 2011 and January 2023. The primary outcome was total opioid consumption during the first 24 postoperative hours. Secondary outcomes included opioid and rescue analgesic use within 0–6, 6–24, and 24–48 h, as well as pain intensity during each interval. Multivariable linear regression analysis was performed to identify factors associated with postoperative opioid consumption. Results: A total of 382 patients were analyzed. Pain intensity peaked within the first 6 postoperative hours, decreased during the 6–24 h and increased during 24–48 h period. Higher BMI and placement of more than three bars were independently associated with greater opioid consumption during the first 6 h (p < 0.001). Within 24 and 48 h, male sex, longer operation time and higher BMI were independently associated with opioid consumption (p < 0.001). During 6–24 and 24–48 h period, VAS severity was significantly higher in male patients and those with longer operation times. Conclusions: Male sex, higher BMI, prolonged operation time, and multiple bar insertion may contribute to greater postoperative opioid requirements during the early postoperative phase in adult patients undergoing MIRPE.